Provider Demographics
NPI:1235385758
Name:JENNIFER P. PATTERSON, DMD
Entity Type:Organization
Organization Name:JENNIFER P. PATTERSON, DMD
Other - Org Name:CHARLESTON SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCGRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-573-0733
Mailing Address - Street 1:1243 SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7817
Mailing Address - Country:US
Mailing Address - Phone:843-573-0733
Mailing Address - Fax:
Practice Address - Street 1:1243 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7817
Practice Address - Country:US
Practice Address - Phone:843-573-0733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3997Medicaid